Mona

:help: I've exhausted all my efforts and my health is quickly fading. I'm 35 yr. old, 5'5 inches with a BMI over 60 and plenty of health problems. I haven't been diagnosed with diabetes yet but my latest labwork this past week shows my insulin levels are too high. The doctor says it would be better if it were around 10---my insulin level is 20.6 and I have gained 34 lb. within the past 30 days. My insurance company which is BCBS of Tennessee says 'their doctor' says Lap Band surgery is not medically necessary for me and that now I must be under a physician-supervised diet for at least six months before they will reconsider. And the psych evaluation that I've already paid out-of-pocket to have per their request is no longer valid--and I passed it with flying colors. I sent my letter of appeal to them the first of this past April. I received a denial letter at the end of April stating that BCBS of TN had rewritten their weight loss surgery policy and the criteria for this surgery is now even tougher. I'm tired and my health is failing. I just need a helping hand...that's all...a helping hand. God help me do what I need to do to survive. Anyone who may read this thread, please say a prayer for me and for my insurance company...Thank you and may God continue to bless you all.:cry

Well it's sad but true. BCBS of TN has denied me for the lap band. I'm definitely not giving up but I'm very discouraged right now.:cry There's not much left for me to do now...I've jumped through all the insurance hoops. I'm tired of jumping now...I've done my part and am still doin' my part. The denial letter was so uniform, cold and....:speechles . I tell myself that I just have to believe that God is gonna see me through all this. Please pray for me.:help:

:faint: Today is 3-3-06, Friday morning--real early(1:35am). I found out through the Gastric Band Institute that I had to schedule and appointment for a psych evaluation as well as attend a pre-op nutrition and information class. So, March 14th I go for my class in Chattanooga at 2:00p and then March 15th (Wed.) I go for my psych evaluation--also in Chatt town.:nervous I am trusting that God will continue to open doors for me. I realize the potential for this to be a life changing experience and I also realize that God has great things in store for me and my husband. I know that I was not called to be THIS overweight:paranoid . I just think of all the things I could do for the Lord beyond what I am right now. I want to realize my full potential as a christian. I am very serious about this transformation in my life---like a butterfly---a metamorphosis. He is the potter and I am the clay...make me, mold me, bend me, break me...just use me Lord for your purposes. Thank you God for lifting me up!:clap2:

:faint: Today is 3-3-06, Friday morning--real early(1:35am). I found out through the Gastric Band Institute that I had to schedule and appointment for a psych evaluation as well as attend a pre-op nutrition and information class. So, March 14th I go for my class in Chattanooga at 2:00p and then March 15th (Wed.) I go for my psych evaluation--also in Chatt town.:nervous I am trusting that God will continue to open doors for me. I realize the potential for this to be a life changing experience and I also realize that God has great things in store for me and my husband. I know that I was not called to be THIS overweight:paranoid . I just think of all the things I could do for the Lord beyond what I am right now. I want to realize my full potential as a christian. I am very serious about this transformation in my life---like a butterfly---a metamorphosis. He is the potter and I am the clay...make me, mold me, bend me, break me...just use me Lord for your purposes. Thank you God for lifting me up!:clap2:

Hey there! Just read your post and thought I'd give some input too. I'm from east tennessee and I have blue cross blue shield insurance. As far as my experience goes, co-morbidities do help your cause but they're not the only thing that insurance companies wanna know about. For example, they also wanna know if you've tried structured, medically based weight loss plans--and failed. And if you've been on a exercise program regularly at least at some point in the past. But in my opinion, if a person is tryin' to have the weight loss surgery then that tells me that they are indeed serious about losing and just need a little extra help. I wish you all the very best on your weight loss journey and many successes. I'm sure you will do great! May God bless you.

Hey there! Welcome to the lapband talk community and I wish you the very best on your journey...I am in the process of having this do too. I'm from east tenn. Is insurance paying for yours or are you financing this?

LOL...your're so funny! And yes, I will also continue to be persistent. I know you'll come out the winner in all this because you have a very stick-to-it attitude and I believe that's just what it takes. Hope you have a great week and I will let you know if anything changes on my end...you let me know too ok? Good night! May God continue to bless you and your efforts.

LOL--I understand about anxiety...I first started taking anti-depressant drugs more than 10 yr. ago--along with anti-anxiety drugs and anything else that could help me feel better about being so fat...I've been to so many counseling sessions I'd rather not say how many--but let's just say I've been to more than my fair share. Anyway, I discovered that the longer I was on these drugs, the more the psych dr. increased my dosage and my sessions--so I swithched dr. and the viscious cycle started all over again...lol...but I dedcided that enough was enough so I took my life back...one day at a time...one step at a time...and I believe a person can do anything they set their mind to doing...EVEN BEING PERSISTENT WITH AN INSURANCE COMPANY...maybe they're yankin' your chain and maybe they're not but in any case, the lady is right...you can push without being pushy...my insurance has changed within the last 2 yr so I have had to start all over with this process and I am well versed by now...Best wishes on your journey!

Hey there! I read your post and thought I'd respond with what little I know. I don't believe that your insurance co. is stallin' for time. I don't know what kind you have but their requirements sound pretty much the same as most insurance companies who need documention before they will approve. My insurance co. required the same thing--basically. In addition I also have to attend a pre-op nutrition class. Most ins. co. require at least a psych evaluation, 6 mth of documention of structured/medically based weight loss attempt, at least one Dr. letter and some require even MORE than that. Just hang in there though...it gets better. I'm still in the waiting process myself. May God bless you in your efforts.

:clap2: Today is 2-24-6 on a Friday. I received a call from my surgeon's nurse today about the next I'll be taking. She reviewed my old psych evaluation from a couple of years ago and said that the psych doctor had not cleared me for surgery. I remember how devastated I was at the time.:think However, looking back...it was probably for the best because I was in the middle of a divorce and was separated from my husband at the time. But now God has brought me through yet another huge obstacle in my life(that I probably help create) and has blessed me with a husband who is understanding and supportive of my efforts to lose weight and have the lap band surgery. :clap2: Now that I have insurance again, I am trying this again. I have my walking/running shoes on this time and I'm feeling very encouraged. Anyway, the nurse Melissa, said she would get me in to see one of their psych doctors who is very good and very supportive of this lap band idea for his obese patients and she told me they would do whatever it takes to get this approved with my insurance company. I thank God for the people at the Gastric Band Institute in Chattanooga--they are God-sents. I told Melissa that I would call back at the end of next week just to check on the progress of my approval. :tired God, grant me the serenity to accept the things I can not change; Courage to change the things I can; And the wisdome to know the difference; Just for today. Amen.

:clap2: Today is 2-24-6 on a Friday. I received a call from my surgeon's nurse today about the next I'll be taking. She reviewed my old psych evaluation from a couple of years ago and said that the psych doctor had not cleared me for surgery. I remember how devastated I was at the time.:think However, looking back...it was probably for the best because I was in the middle of a divorce and was separated from my husband at the time. But now God has brought me through yet another huge obstacle in my life(that I probably help create) and has blessed me with a husband who is understanding and supportive of my efforts to lose weight and have the lap band surgery.:mad: :clap2: Now that I have insurance again, I am trying this again. I have my walking/running shoes on this time and I'm feeling very encouraged. Anyway, the nurse Melissa, said she would get me in to see one of their psych doctors who is very good and very supportive of this lap band idea for his obese patients and she told me they would do whatever it takes to get this approved with my insurance company. I thank God for the people at the Gastric Band Institute in Chattanooga--they are God-sents. I told Melissa that I would call back at the end of next week just to check on the progress of my approval. :tired God, grant me the serenity to accept the things I can not change; Courage to change the things I can; And the wisdome to know the difference; Just for today. Amen.

Today is 2-23-6 on a Thursday. I faxed a five page letter to my surgeon's office today. The nurse, Melissa, will be sending it along with some other information to BCBS of TN. The nurse, Robin, from BCBS who reviewed my information so far says they need documentation of a psych evaluation within the past two years as well as documentation that I have been on a structured weight loss plan within the past two years at some point. Melissa from Dr. Paynter's office said she was going to try and pull some strings and see if she can't get her hands on my psych evaluation from two years ago about this time when I first pursued this procedure. :nervous I have prayed about this several times and I believe that God will make a way. I prayed that if it is His will then He will open up the doors of opportunity for me to do this and if it is not His will then he will close the doors. However, I realize that doesn't mean I just give up. I will continue to be persistent in this endeavor because otherwise all my efforts have been in vane. I did ask God that if it was at all possible that He would make a way and open up doors for me to do this and that He would lead me down this road. I realize it took awhile for me to put all this weight on and it will take awhile for me to take it off(and keep it off).:mad: God, grant me the serenity to accept the things I can not change, Courage to change the things I can, And the wisdom to know the difference, Just for today. Amen

Today is 2-23-6 on a Thursday. I faxed a five page letter to my surgeon's office today. The nurse, Melissa, will be sending it along with some other information to BCBS of TN. The nurse, Robin, from BCBS who reviewed my information so far says they need documentation of a psych evaluation within the past two years as well as documentation that I have been on a structured weight loss plan within the past two years at some point. Melissa from Dr. Paynter's office said she was going to try and pull some strings and see if she can't get her hands on my psych evaluation from two years ago about this time when I first pursued this procedure. :nervous I have prayed about this several times and I believe that God will make a way. I prayed that if it is His will then He will open up the doors of opportunity for me to do this and if it is not His will then he will close the doors. However, I realize that doesn't mean I just give up. I will continue to be persistent in this endeavor because otherwise all my efforts have been in vane. I did ask God that if it was at all possible that He would make a way and open up doors for me to do this and that He would lead me down this road. I realize it took awhile for me to put all this weight on and it will take awhile for me to take it off(and keep it off). God, grant me the serenity to accept the things I can not change, Courage to change the things I can, And the wisdom to know the difference, Just for today. Amen

Hey there Audra! Read your message just now. The nurse at my surgeon's office told me to call my insurance company every 2-3 days to check on the progress. I was nice and waited a week first...lol. Anyway, my info was reviewed on Feb. 8th and the nurse that reviewed my info at my ins. co. (BCBS of TN) sent a reply back to my surgeon's office on the 16th. I definitely understand how you feel. I'm jumpin' through all their hoops too. I am morbidly obese and have all kinds of co-morbidities and I have had a psych eval many times over within the past 10 yr. of my life. However, the ins. co. told me that they needed documentation that I had been evaluated within the past 2yr and they need documentation that I had tried structured weight loss within the past 2 yr. as well. The ins. co. has been sent all kinds of medical documentation about my depression and weight gain (and weight loss) from the past 7-8 of my life but they want more so....I'm gonna give um' more...lol. Just don't give up!

Hey there! The surgeon I am seeing had his nurse send my insurance info certified or registered mail so the insurance company would have to sign for it when they got it. Just today I faxed my personal letter to my surgeon's office and the psych evaluation has not been sent to them yet either. I don't think it really matters if it's not all sent at the same time. You may wanna ask your doctor's nurse if they sent the info certified mail and if not then anything you send to your insurance be sure and certify it. This just keeps the ins. co. from saying they never received your info no matter how many different times you need to send something to them. I wish you the best in all this. I too am waiting for ins. approval and I too have been patient and have jumped through all their " hoops ". Just hand in there though. May God bless you in this.

I'm so excited for you and your cruise trip. And I don't blame ya for wantin' to live it up a little bit without restrictions. This could be a great ending to this chapter in your life. When you get the band, it will start a new one--ya know? I also agree with starting a more structured way of eating and excersing too (before the band). I know all about structure. I haven't had a problem with losing weight...I've done it off and on for 10 years now. It's keeping it off. I believe that the lap band is only a tool but one that will help me and many others finally realize their weight loss potential and keep it off. I'm rootin' for ya in all this too. Guess we all just gotta stick together on this thing. Well, may God bless you.

:welldone2: Thank you for the great advice and I definitely agree with that. I am well versed in good eating habits--I used to be a huge fitness nut:biggrin1: . When I stopped working out and eating right is when I started gaining alot of weight--then I got depressed and it just snow-balled. However, I haven't given up on that athletic body I had just 10 short years ago. Thanks a bunch for the encourement! May God bless you!

Good for you Josette! I'm from east Tennessee and I'm using the Gastric Band Institute in Chattanooga with Dr. Paynter. So, welcome and keep me posted on your progress. May God bless you during this time.

:mad: Hey there. My first name is actually Ramona but I go by carroline. I just thought 'Mona' seemed a little different. Anyway, thanks for the reply. I'm from east Tennessee near Chattanooga. I'm working hard to "get all my ducks in a row" so to speak. Today I found out that I have to go for a psych evaluation and I have to show my insurnace company that I have been on some sort of structured diet plan within the past two years. But then again, I have been on a structured diet plan off and on for the past 10 years and I haven't been able to keep off the weight. Oh well, go figure I guess...lol. God is in control of this thing anyway so I don't have to sweat it. Hope all is well with you and I hope to hear from you soon. May God continue to bless you.:car:

Hey Karen! I'm so excited for you in this. But what do you mean 'waiting for the surgeon to be re-certified'? I guess it doesn't really matter just so long as a good surgeon can do this for you. It has been a long road for me as well. And I agree with your scripture verse "I can do all things...". I'm a christian and I believe that the Lord is gonna see us through this journey. I hope to get to continue to talk with you through this journey. May God bless you.

Hey there Dana! Well, I started this journey a little over 2 yr. ago with another insurance company--United Health Care. They were going to pay 90%! However, I was in the middle of a divorce and when it was final then I lost my health insurance(it was through my husband's work . I have learned since then that a large # of health insurance companies will turn down a perspective candidate for this surgery. Then the patient has to go through the appeal process. My doctor told me that this was normal and that some insurance companies wanna know who is serious about this and if they will be persistent. I'm very sure that you and all the rest of us are very serious about having this surgery and for some of us, it is a matter of life or death. I'm not trying to write a book with this answer but I guess I just want you and everyone else to know that persistence will pay off and when insurance companies say "No", sometimes they are just trying to weed out the fickle candidates. I would really like to talk with you some more about this or anything else involving this surgery. I'm just so excited that I finally get to discuss this with a tennessee person with BCBS . I look forward to more messages from you. May God bless you through this walk.

Hey there! How are you today? I saw where you had BCBS of TX. Well, I've got BCBS of TN. I also saw where your info was sent on the 8th. The nurse at my surgeon's office said my ins. co. received my letters and info on the 8th of this month. They sent it certified mail so the insurance company would have to sign for it. I talked to my insurance company and the lady said that assuming all the info they need is there then, it generally takes 7-14 business days to receive a response about approval. Feb. 27th will be exactly 14 business days but I'm thinkin' I'll probably call them tomorrow and check on the progress. Just hang in there and be persistent. I wish you well.

Cogratulations! I don't have Cigna but I do have BCBS of TN and I too am waiting for approval. My gyn and PCP have both submitted letters of recommendation as well. The Gastric Band Institute that I am using sent the past 7 years worth of proof that I provided them--including regularly attending a workout program at my local YMCA. I had a sleep study done 2 weeks ago too and am waiting the results of it as well. Well, keep up posted on your progress and may God bless you in this journey.

Hey there and welcome! I'm sorta new here too. Congratulations on the band. So how long have you had it? I'm still waitin' on my insurance approval letter. I've been thinkin' bout doin this for 2 yr now. Best wishes on success of this for you. Hope to hear from you sometime.

Yeah this is true. My current husband is very supportive of this whole experience. He has lost quiet a bit of weight himself--of course, I believe men lose weight faster and easier than women--not all but a great # of them anyway--in my experience. My husband knows exactly what's gonna be involved and he just said 'whatever it takes to make me happy'. Yes, I am blessed but I couldn't say that of my ex-husband when all this first started about 2 yr ago. Hope to talk to yall soon. Have a great day!